14 Chapter 1 AIMS AND OUTLINE OF THIS THESIS The aims of this thesis are to evaluate the impact of Achilles tendinopathy, to assess the role of ultrasonographic imaging and to assess socio-economic status as prognostic factor in Achilles tendinopathy patients. Currently, there is considerable variation in the outcome measures used for Achilles tendinopathy, which can have implications for patient care, as healthcare professionals and researchers are unable to adequately interpret, compare, and synthesize study results for meta-analyses. In Chapter 2 we performed an international Delphi survey and consensus meeting to agree to a set of core outcome measures for clinical trials on Achilles tendinopathy. This will advance the comparability between future studies in this field. Calf muscle strengthening exercises are an important part of the treatment of Achilles tendinopathy. A frequently used test to assess calf muscle strength endurance is the single-leg heel rise endurance test (HRET). In Chapter 3 we established normative values for the HRET in a large population of healthy individuals as these are currently lacking for the general population. In Chapter 4 we investigated the impact of Achilles tendinopathy on quality of life and compared this to other prevalent musculoskeletal conditions. We also studied the impact of Achilles tendinopathy on work performance and health care utilization as well as the associated costs of Achilles tendinopathy. It is useful to know whether patients with Achilles tendinopathy can adequately localize their pain and distinguish between the insertional and midportion region as this effects prognosis and treatment. In Chapter 5 we evaluated the level of agreement between patient-reported pain using a standardized pain map and the physician-determined clinical diagnosis of Achilles tendinopathy. Ultrasound Tissue Characterization is a valid imaging method to evaluate tendon structure and is widely used in clinical research, but knowledge on the reliability of tendon thickness measurements is lacking. In Chapter 6 we determined the intra-rater and inter-rater reliability for Achilles tendon thickness measurements using UTC and assessed if these measurements can be reliably translated to conventional ultrasound. In Chapter 7 we obtained reference values for Achilles tendon thickness on ultrasound in a large asymptomatic population and compared these to patients with Achilles tendinopathy. These values can help clinicians distinguish between normal morphological changes and abnormalities and enhance the diagnostic process. Knowledge on health disparities between different populations can help clinicians to optimize treatment for the individual patient. In Chapter 8 we evaluated if socio-economic status, measured by factors such as place of residence, age, gender, education level and
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